Thursday, June 8, 2017

Copaiba for treating arthritis: Silver bullet or snake oil?

Sales of the essential oil copaiba [koh-pey-buh] are increasing, at
least in part, because more than 54 million Americans suffer from some
form of arthritis and 23.7 million are limited in their usual activity
primarily due to pain. The conventional way to treat arthritis is using
nonsteroidal, anti-inflammatory drugs (NSAIDs) as well as
cyclo-oxygenase-2 inhibitors (COXIBs), which are not without adverse
events like gastrointestinal bleeding, heart attacks and stroke. For
arthritis sufferers, copaiba may turn out to be a silver bullet or,
perhaps, snake oil.

The side effects of NSAIDs and COXIBs as well as warnings from the
U.S. Food and Drug Administration on their risks of gastrointestinal
side effects and bleeding as well as cardiovascular disease all suggest
the need to test novel therapies with potential clinical benefits and
fewer side effects than the available traditional medicines. One such
possible remedy is Copaifera reticulate or copaiba.

The totality of evidence concerning the potential of copaiba to
treat inflammatory arthritis is limited to basic research and
uncontrolled clinical observations in humans. Researchers from Florida
Atlantic University caution that randomized trials are necessary to
discern whether the treatment is effective or that copaiba turns out to
be "yet another beautiful hypothesis slain by ugly facts." They present
the incomplete totality of evidence and challenges in treating arthritis
in their commentary published in the journal Integrative Medicine.

"Copaiba is an essential oil that is used topically with little or
no side effects, but there is insufficient evidence to judge whether it
reduces pain and inflammation in patients with arthritis," said Charles
H. Hennekens, M.D., Dr.P.H., the first Sir Richard Doll Professor,
senior academic advisor to the dean in FAU's Charles E. Schmidt College
of Medicine, and senior author of the paper. "In case reports,
individuals with joint pain and inflammation who used copaiba reported
favorable results, however, this hypothesis is promising but as of yet
unproven."

Copaiba is a stimulant oleoresin obtained from the trunk of several
pinnate-leaved South American leguminous trees found in the Amazon. Its
medicinal usage dates back to the 16th century when natives of Brazil
used it as folk medicine. Today, Brazil produces approximately 95
percent of this oil-resin, exporting more than 500 tons each year.

"Basic research has suggested mechanisms of benefit of this
essential oil in treating inflammatory arthritis," said Hennekens.
"Nonetheless, the only published data on copaiba on humans includes one
case series and one small randomized trial of another inflammatory
condition and not arthritis."
In the commentary, the researchers conclude that the totality of the
currently available evidence for copaiba essential oil is wholly
insufficient to judge either its benefits or risks for the relief of
pain and inflammation in arthritis. They emphasize that despite the
absence of reliable evidence from large-scale randomized clinical
trials, sales of copaiba continue to increase, presenting clinical and
public health challenges.

"To complete the totality of evidence, copaiba should be first
tested in a randomized trial against a placebo in patients with
inflammatory arthritis," said Hennekens. "If such a trial shows a net
benefit, then the next step would be direct randomized comparisons
against NSAIDs and COXIBs."